Transforming the Doping Culture: Whose responsibility, what responsibility?

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ACTA UNIVERSITATIS

UPSALIENSIS

Digital Comprehensive Summaries of Uppsala Dissertations

from the Faculty of Medicine

931

TRANSFORMING THE

DOPING CULTURE

Whose responsibility, what responsibility?

ASHKAN ATRY

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Dissertation presented at Uppsala University to be publicly examined in Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, Friday, October 11, 2013 at 13:15 for the degree of Doctor of Philosophy. The examination will be conducted in English.

Abstract

Atry, A. 2013. Transforming the Doping Culture: Whose responsibility, what responsibility?. Acta Universitatis Upsaliensis. Digital Comprehensive Summaries of Uppsala Dissertations

from the Faculty of Medicine 931. 74 pp. Uppsala. ISBN 978-91-554-8738-6.

The doping culture represents an issue for sport and for society. Normative debates on doping have been mainly concerned with questions of the justifiability of doping. The practice of assigning responsibility for doping behaviour has chiefly been individual-based, focusing mainly on the individual athlete’s doping behaviour. The overarching aim of this thesis is to investigate the relevance and the importance of the ideas of responsibility in relation to ethical debates on doping. The more specific aim is to examine the possibility of broadening the scope of responsibility beyond the individual athlete, and to sketch a theoretical framework within which this expansion could be accommodated. In the first study, it is argued that bioethicists have a moral/professional responsibility to start out from a realistic and up-to-date view of genetics in ethical debates on gene doping, and that good bioethics requires good empirics. In study 2, the role played by affective processes in influencing athletes’ attitudes towards doping behaviour is investigated, both on an individual and on a collective level. It is concluded that an exclusive focus on individual-level rule violation and sanctions may entail overlooking the greater social picture and would prove to be ineffective in the long term. In study 3, the common doping-is-cheating arguments are examined and it is argued that they fail to capture vital features of people’s moral responses to doping behaviour. An alternative account of cheating in sport is presented in terms of failure to manifest good will and respect. It is concluded that putting cheating in the broader context of human interpersonal relationships makes evident the need to broaden the scope of moral responsibility and agency beyond the individual athlete. In study 4, the particular case of assigning responsibility for doping to sports physicians is used to examine the current individual-based approach to responsibility. This approach underestimates the scope of the responsibility by leaving out a range of other actors from the discourse of responsibility. The central conclusion of the thesis is that transforming the current doping culture requires broadening the scope of responsibility to include individuals and groups of individuals other than the athletes themselves.

Keywords: Doping; responsibility; prospective responsibilities; cheating; good will;

interpersonal relations; sports

Ashkan Atry, Uppsala University, Department of Public Health and Caring Sciences, Box 564, SE-751 22 Uppsala, Sweden.

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List of Papers

This thesis is based on the following papers, which are referred to in the text by their Roman numerals.

1. Atry, A., Hansson, M. G. and Kihlbom, U. (2011). Gene doping and the responsibility of bioethicists. Sport, Ethics and Philosophy, 5(2): 149– 160.

2. Atry, A., Hansson, M. G. and Kihlbom, U. (2012). Beyond the individu-al: sources of attitudes towards rule violation in sport. Sport, Ethics and

Philosophy, 6(4). DOI:10.1080/17511321.2012.739194.

3. Atry, A., Hansson, M. G. and Kihlbom, U. (2013). Cheating is the name of the game– Conventional cheating arguments fail to articulate moral responses to doping. Physical Culture and Sport. Studies and Research (In press).

4. Atry, A., Hansson, M. G. and Kihlbom, U. (2013). Doping and the par-ticipatory responsibility of sports physicians. Submitted

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Abbreviations

BMA Board of Science and Education EPO Erythropoietin

GTT Gene Transfer Technology

IOC International Olympic Committee THG Tetrahydrogestrinone

USADA United States Anti-Doping Agency WADA World Anti-Doping Agency

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Introduction

Je n'ai pas inventé le dopage…J'ai simplement participé à ce système. Je suis un être humain Lance Armstrong, American cyclist 1

Today, the current pervasive doping culture represents an issue for sport and society. Normative debates on the ethical status of doping have been mainly concerned with the questions of justifiability (i.e., whether or not, and on what grounds, it should be allowed in sport). This thesis represents an effort to call attention to the relevance and the importance of the ideas of responsi-bility in relation to ethical discussions of doping in sport. The practice of responsibility assigning in relation to doping behaviour has primarily been individual-based, focusing mainly on the individual athlete’s doping behav-iour. Consequently, individual athletes are commonly held responsible for doping behaviour and seen as “drug-cheats” who, as if in a vacuum, exercise autonomy over their desires, aspirations, decisions and actions, and who rarely, if ever, act out of coercion or under other forms of external pressure.

In the wake of a doping scandal, we sometimes see young athletes on TV screens who confess in front of millions of viewers to their doping offences, and who often in a highly emotional state literarily cry out their feelings of guilt and remorse. In contrast, a cyclist on the sports news a few years ago was annoyed by the questions about the occurrence of doping in the tourna-ment and unexpectedly turned to the camera and said something along the lines of “you expect us to hold an average speed of X, while you know that it is humanly impossible [without EPO].” His comment was followed by an uncomfortable and disturbing silence. It seemed like his response had re-versed the relation between the judge and the judged in an uncanny way, and, had turned the camera towards those who stood behind the cameras or sat in front of the TV sets and judged him. By the same token, the rider’s comment regarding the expectations of the fans also revealed the other side of the responsibility assigning “coin”: its second-personal dimension. In an analogous sense, this thesis could be seen as an attempt to turn the responsi-bility seeking analytic “camera” towards the sport community and society. It

1_{“I did not invent doping…I just participated in this system. I am [just] a human being (Le}

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seeks to examine the question of responsibility in relation to doping behav-iour beyond the individual athlete.

The core argument of this thesis is that individual-based conceptions of responsibility in relation to doping behaviour are problematic, and ineffec-tive in coping with the complexity of doping culture. I endeavour to outline an alternative view of responsibility in relation to doping behaviour based on social practice, which better depicts the way we experience the exercise of responsibility assignment in relation to doping behaviour. This alternative view will also offer considerable possibilities for broadening our conception of responsibility and its scope, and for developing preventive measures con-cerning the doping culture. The basic tenet will be the idea that the practice of responsibility involves an indispensable social component in that both the judge and the judged are to be viewed as socially embedded. This relational aspect of responsibility implies that the person who assigns responsibility and the person to whom responsibility is assigned stand in a reciprocal rela-tionship.

To this end, the thesis stresses the need to broaden the conception of re-sponsibility in relation to doping, and to extend the scope of rere-sponsibility to include actors other than the athletes themselves, who are in one way or the other involved in or connected to the current doping culture (e.g. coaches, sports physicians, fans, sponsors, media, sports journalists). As will be ar-gued in Study 1, this also includes bioethicists who are involved in ethical debates on doping. For instance, they have a moral and professional respon-sibility to be well informed about genetics. The intention here is not to come to a conclusive normative conclusion about the ethical status of doping. There is admittedly no harmony of interests in this regard. I simply proceed from the problematic nature of the current doping culture (few would deny that doping currently is an issue) and endeavour to understand why and how we assign responsibility to actors in relation to doping behaviour.

The disposition of the thesis is as follows: In the next section, entitled “Background,” I will attempt, in general terms, to acquaint the reader with definition, history, and prospects of the doping phenomenon in sport. The section ends with a bird’s-eye view of current philosophical debates for and against doping. The section “Aims and Questions” introduces the main ques-tions that the thesis sets out to answer. In the section “Methods,” presenting common methodological approaches in bioethics, I will defend the approach embraced in this thesis, referred to as empirically well-informed bioethics. This will be followed by a summery of four studies included in the thesis. In the section “Discussion,” drawing on the arguments presented in these four studies, I will attempt to further elaborate on the conception and the scope of responsibility in relation to doping behaviour, and to raise the question whether responsibilities in this regard could be assigned to groups such as athletic subcultures, and if so, to what extent. Before presenting the conclud-ing remarks, suggestions regardconclud-ing future research will be provided.

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Background

What is Doping?

Generally speaking, “doping” refers to the use of illicit substances and methods by athletes in order to improve athletic performance. There are many ways to enhance athletic performance; some of which are permitted (e.g. training, diet) and some are prohibited (e.g. growth hormones) by sports’ governing bodies. The use of drugs in sports was officially recog-nised as problematic first during the 1950’s and the early part of the 1960’s. The International Olympic Committee (IOC) passed its first anti-doping resolution in 1962. Under the initiative of the IOC, the World Anti-Doping Agency (WADA) was established in 1999 in order to come to terms with doping issues in sport internationally. WADA defines doping as “the occur-rence of one or more of the anti-doping rule violations set forth in Article 2.1 through Article 2.8 of the Code” (World Anti-Doping Code, sec. I). The above violations refer to “presence of Prohibited Substances or its

Metabo-lites or Markers in an Athlete’s bodily Specimen (sec. 2.I) and the “Use or Attempted Use of a Prohibited Substance” (sec. 2.2). WADA’s “Prohibited

List” includes substances that stratify these conditions:

1. Scientific evidence or experience that demonstrates that the meth-od or substance has the potential to enhance, or enhances, sport performance;

2. Medical evidence or experience suggests that the use of the sub-stance or method represents an actual or potential health risk to the athlete;

3. The use of the substance or the method violates the spirit of sport2_.

Doping substances vary according to the nature of the specific sport. For instance, stimulant substances such as amphetamines might be used in sports such as baseball, which involve long periods of tournament and numerous games, while steroids might be an attractive choice in sports such as weight lifting and rowing, which benefit from greater muscle mass. In endurance sports such as cycling, where an increase in the oxygen-carrying capacity of the blood is vital to performance, EPO (a substance called erythropoietin the

2_{See article 4.3 in the WADA Code, http://www. wadaama.org/rtecontent/}

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use of which increases the number of red blood cells) is sometimes used. Alongside doping substances such as EPO and steroids, WADA’s “Prohibit-ed List” also includes doping methods such as “blood doping” (transfusion of haemoglobin-rich blood before the match), and masking agents, that are used to conceal the use of doping substances, e.g. plasma expanders that are used to cover the use of EPO. The majority of doping practices involve drugs (DeFrancesco, 2004).

Definitional and Boundary-Drawing Issues

Since the acknowledgment of doping as a problematic issue in competitive sports, questions have arisen about what counts as doping and the definition-al and boundary-drawing difficulties in this regard still give rise to argu-ments concerning doping today. The enhancement of athletic performance is obviously not a new phenomenon. For years, athletes have attempted to en-hance their performance via different diets, training methods, and gear. Per-formance-enhancing substances were supposedly even used by gladiators in Ancient Rome, who drank some sort of herbal mixture to increase their physical strength before a battle. The introduction of racing shoes to foot race entailed some kind of foot-enhancement that allowed the runners to perform better. One may ask in what way pharmaceutical substances differ from running shoes regarding the enhancement of athletic performance? Where should we draw the line between what should be considered to be appropriate performance-enhancing substances and methods and what should be considered inappropriate?

An early attempt to define doping was made by Cava, who defined dop-ing as “the use of energy-providdop-ing substances other than food, aimdop-ing to increase competitive output in advance” (Cava, 1962: 53). This definition is clearly insufficient in scope, since not all doping substances are “energy-providing” (e.g. beta-blockers). Another rather appealing (and perhaps most commonly assumed) way of defining doping would be to refer to any use of “unnatural” or “artificial” means to enhance one’s performance. In the early days of doping monitoring, in order to distinguish doping from acceptable means of performance enhancement, a line was drawn between “natural” means of performance enhancement (e.g. diet, training) and “unnatural” means (i.e., those substances that were banned). Thus, doping was consid-ered to be an “unnatural” or “abnormal” way of enhancing one’s perfor-mance. This view is held by many still today. However, as the current de-bates on the subject matter show, drawing a strict boundary between what is “natural” and what is “unnatural” is as difficult as it is to draw a line be-tween “normal” and “abnormal” (Tamburrini, 2009). For instance, many East African endurance runners seem to have higher red blood cell count,

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which entails an increase in oxygen uptake in the blood, and thus an increase in endurance.

The debates on natural/unnatural distinctions are closely related to de-bates on normal/abnormal and artificial/non-artificial distinctions. One could, for instance, maintain that what constitutes a “natural” way of partici-pating in a bicycle race is to rely solely on one’s “normal” physical abilities (muscles and lungs) without the use of “artificial” substances or methods (e.g. EPO). Then again, referring to such notions as “artificial” or “natural” raises the question of what counts as “natural” or “artificial”. Are, for exam-ple, different nutritional substances used by athletes necessarily “natural”? Is there a fundamental and morally relevant difference between the use of syn-thetically produced vitamins and minerals and those found in nature? Given the ambiguity of the term “natural”, a definition of doping based on the dis-tinction between “natural” and “artificial” means of performance-enhancement seems to be a very difficult position to defend. Doping and training are both artificial forms of enhancing one’s performance. The ques-tion nevertheless is whether there is a fundamental morally relevant differ-ence between these two forms of artificiality. Perhaps what we refer to as enhancement in sport is simply different kinds of artificiality, and what seems to be problematic is deciding upon a clear boundary between what is acceptable and not acceptable in this regard. As Ellis Cashmore, a critic of anti-doping rules, argues:

Let’s say four teams of long distance skiers want a competitive edge. Austria opts for blood doping to pump up the desired oxygen-carrying blood cells. Finland achieves much the same result, but by training at altitude. Germany also trains at altitude in, say, Kenya, last year, extracts the enriched blood from its athletes and then transfuses their own blood back prior to the games. Denmark instructs its athletes to sleep in hypobaric chambers. All achieve the same results via different methods. Under current rules, Austria and Germany are cheating. How come? This is not logically consistent; it is arbitrary and hypocritical. (The Olympics Meets the War on Drugs)3

To put the question differently, in what way can the above four enhancement devices, or EPO and gene therapy, be said to corrupt or highlight the excel-lence that the skiing sport is meant to display? More importantly, do these four methods, producing the same effect on performance (i.e., increasing endurance by heightening the blood’s oxygen-carrying capacity), differ in profound ways that are morally significant? Conceivably, a less ambiguous way to determine a division between the appropriate and inappropriate per-formance-enhancing methods or substances is to refer to the primary internal purpose of competitive sport. This purpose could be understood in terms of

3_{Available at: http://stopthedrugwar.org/chronicle-old/424/olympics.shtml (accessed}

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the measure of athletic skills and talents (the “spirit” of sport). The spirit of sport could then provide a criterion for determining whether a method or a substance promotes this purpose or otherwise undermines it. Morgan argues that:

When one’s winning of a foot race or any other sport is owed in some signif-icant measure to how one’s body contingently and favourably responds, say, to a steroid, that win is compromised by the fact that how one’s body hap-pens to respond to a drug is not a bona fide athletic talent or skill because it has nothing important to do with what an athletic test is supposed to be about. (Morgan, 2006:126)

Another approach is offered by Loland & Caplan (2008). They admit that there are no given answers to which performance-enhancing substances or methods should or should not be permitted in sport. Yet, they remain opti-mistic regarding the possibility of reaching consensus about which perfor-mance-enhancing methods or substances to permit and which to prohibit. Beside safety and fairness considerations, at the heart of their approach lies the notion of “responsibility for performance”, in that “performance should be the result of athletic effort” (ibid.: 72). Thus, a possible boundary drawing strategy could be formulated in terms of the spirit or the rationale of sport:

Many performance-enhancing technologies are of key value and constitu-tive of sport. Athletes interact in admirable ways with sport equipment such as skis, bikes, skates, and soccer balls. In training and preparation, athletes also interact with a variety of technologies that include weights, training machines, and technological devices that measure air and water resistance as related to movement patterns and body positions, etc. Successful outcomes of these interactions depend on athletic effort and skill. As long as there is equal access among competitors, they are in line with and to a certain extent enforce the spirit of sport. However, most performance-enhancing technolo-gies, such as the use of most of the substances on WADA’s Prohibited List, are considered to provide performance enhancement without athlete effort and skill. Their successful use depends primarily on their correct administra-tion usually guided by external expertise. In addiadministra-tion, most of these means imply significant risks of harm. Upon their use, athletes end up in vulnerable positions in which the nature and consequences of technology use must be carefully overseen by others. Athlete autonomy is threatened. Sport, as a measure of athletic effort and performance, loses its significance. (Ibid.: 74)

Nevertheless, those rejecting the restriction of performance-enhancing substances (e.g. Tamburrini, 2006) still insist that there is no incongruity between the use of such substances and the purpose, or the rationale, of the modern competitive sport. Tamburrini rather considers modern competitive sports in terms of being “driven by a desire to expand the boundaries of what hitherto was considered to be humanly possible”, and says that the purpose

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of athletic competition is “to expand the limits of our capacities” (ibid.: 203). It is to some degree true that the recent regulations about professionalism have virtually turned modern sports into a job, but the question of what ex-actly it is that drives modern competitive sports remains an open question, and is not necessarily limited to the rather idealistic notions such as expand-ing the horizons of what is humanly possible. It remains an empirical ques-tion whether professional athletes themselves, or even any who dope them-selves for that matter, actually view their activity in such idealistic terms as Tamburrini suggests. For instance, one may understand doping phenomena with regards to the enormous financial stakes involved in modern profes-sional competitive sports such as football. In this sense, the “desire” that “drives” competitive sports, and a possible rationale (among other factors) for doping behaviour, could for instance be interpreted as a desire to over-come poverty or to achieve fame and fortune. Nonetheless, the understand-ing of dopunderstand-ing as somethunderstand-ing that undermines the individual’s athletic effort seems to be more in line with the common understanding in the sport com-munity and among general public.

Considering competitive sport in terms of its purpose or the rationale pro-vides a constructive starting point for further discussions about what perfor-mance-enhancing methods or substances should be permitted. Yet, the issue of boundary drawing regarding performance enhancement in sport can also be considered from the broader perspective of human enhancement. On the broader social and cultural level, there seems to be a tension between a liber-tarian desire for limitless enhancement of human physical and mental traits and the sociocultural breaking mechanisms which impose limits in this re-gard. Boundary-drawing issues in relation to performance enhancement in sport can be seen as a partial reflection of the aforementioned tension. Thus understood, on a broader level it is not as much about the permissibility of a particular performance-enhancing substance or method, but rather about the degree to which athletes should be allowed to enhance their physical and mental traits. Though boundary drawing in the case of performance en-hancement remains problematic, I believe it is necessary to continue debate this matter. It cannot automatically be concluded that no boundaries should exist simply based on the fact that it is difficult to draw strict boundaries between what is permissible and what is not. Altogether abandoning bounda-ry-drawings regarding performance enhancement in sport could lead to an unhealthy quest for ever more effective methods and substances.

Common Doping Substances and Methods

The purpose of the use of doping substances and methods in sport is to en-hance physical abilities (e.g. speed, endurance, or strength), as well as men-tal abilities. Common doping methods include “blood doping” (alternatively,

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EPO-doping), as well as physical and chemical manipulation (e.g. anabolic steroids). Drugs in sport could be divided into two categories: (a) “work-enhancing”, and (b) growth-stimulants (Loland, 2002: 79). These drugs can enhance the athlete’s performance when used recurrently. For instance, the administration of erythropoietin (rEPO) may lead to an increase in the pro-duction of red blood cells, enhancing oxygen transportation, which in turn leads to an increase in endurance. Another example is the use of beta-blockers in shooting sports, which reduces the heart beat range, hence allow-ing for more control over performance anxiety.

Brief Modern History of Doping

Performance-enhancing methods are perhaps as old as sport. However, ath-letes’ attempts to enhance their performance by means of different pharma-ceutical substances can be traced back to the introduction of synthetic testos-terone during the 1930’s (Donohoe & Johnson, 1993; Hoberman, 1997). The first known account in medical literature was published in 1865 in the

Brit-ish Medical Journal, and refers to the exclusion of a swimmer from an

Am-sterdam canal race for taking an anonymous performance-enhancing drug (MacAuley, 1996). What characterises the modern approach to performance enhancement in sport is the systematic approach taken by modern medical science towards athletic performance and its application to sport in the form of medical technology, as it has developed from the beginning of the 20th century until today. This brought about radical structural changes in sport competitions. Today, the traditional role played by the medical support sys-tem goes beyond providing treatment of injuries. The recent developments in sports medicine and the application of medical technology can arguably be seen as an extension of the traditional forms of training methods in elite lev-els of sport. The picturesque image of the gentleman athlete training alone or with a friend at the sea shore, as in the film “Chariots of Fire”, seems far removed from the reality of today’s modern elite sport. During the last cen-tury, top-level elite athletes came to be increasingly dependent upon medical doctors and other experts in physical performance for advice and supervision in their quest for optimal performance and gaining a competitive edge.

In the post-Second World War era and during the Cold War, the victories of Soviet and East German athletes at the Olympic games and other world championship events marked a new era in the history of doping. Doping came to gain political dimensions in the form of systematic state-sponsored doping programs used as a means of producing top athletes in order to obtain status on the international scene. In the West, suspicions began to arise re-garding “Communist” athletes who were depicted as some sort of “despiritu-alised automaton, the sportive alien” (Hoberman, 1997: 194). These suspi-cions were confirmed during the 1950’s, when gender testing revealed male

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and quasi-male imposters among female athletes from the Eastern Block (ibid.: 195). Decades later, during a public hearing on the alleged miscon-duct of the former East German physicians, reports about illicit organ trans-plantation and experimentation with steroids on young female athletes (sometimes without their knowledge) echoed for many in an uncomfortable manner the Nazi medical practices4_{. Many in the West drew parallels}

be-tween the Nazi medical practice and the East German State-run doping pro-gram. However, as Hoberman shows, in spite of Germany’s long tradition of sports medicine, dating back to 1920’s, the Nazi state showed no interest in athletic performance enhancement. For Nazis, physical culture was not inter-ested in pursuing athletic world victories or in producing a “bunch of sick and artificially bred outsiders”, “the Nazi authorities regarded the perfor-mance as less important than the politically correct attitude of the performer” (ibid.: 211).

In the course of the 1954 World Weightlifting Championship in Vienna, Dr. John Ziegler, the team physician to the U.S. weightlifting team, obtained evidence that Soviet sports scientists had been experimenting with perfor-mance-enhancing effects of testosterone on Soviet athletes (Todd, 1987; Voy, 1991). According to Voy, upon his return to the U.S.A., Ziegler, who had been impressed by the muscle-building effects of testosterone, helped the CIBA Pharmaceutical Company to develop the drug Dianabol (methandrostenolone) (Voy, 1991: 9). Ziegler convinced three U.S. weight-lifters to use Dianabol and the immediate performance-enhancing effects on strength and muscle building was evident. This, according to Voy, initiated the widespread use of anabolic steroids in late 1950’s and during 1960’s (ibid.: 10). Years later, faced with what sometimes were devastating side-effects of taking high doses of steroids, Ziegler “realized the mistake he had made by helping to introduce these drugs to the athletic community…[he] knew he had created a monster, a fact he regretted for the rest of his life” (ibid.: 10). There seems to be an agreement that the tragic death of the Dan-ish cyclist Knut Jensen in 1960 during the Rome Olympics triggered the anti-doping campaign. It was then well known that the use of stimulants, such as amphetamines, was prevalent in cycling (Pound, 2004).

The first systematic scientific approach to the performance-enhancing ef-fects of blood doping was made by Professor Björn Ekblom and his associ-ates in Sweden during the late 1960’s and early 1970’s. Blood doping in-volves removing and storing the athlete’s blood for reinfusion prior to a competition, causing a boost of oxygen-carrying capacity of the blood and thereby increasing strength and endurance. Ekblom’s findings indicated con-siderable enhancement in performance as the result of blood doping (Donohoe & Johnson, 1986: 116-117). Similar studies were carried out by sports scientists and physicians during the 1970’s and early1980’s, with

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more or less the same results as Ekblom’s. Some studies were aimed at de-veloping proper and more effective methods of blood doping (Williams, 1981). There were scholars who were critical to blood-doping techniques during the 1970’s and early 1980’s (e.g. Williams & Sperryn, 1983, see also Waddington, 1996). However, the main concern revolved around the issue of safety rather than the consideration of fair play, and the research remained legitimate. The situation changed when in the Los Angeles Olympics 1984; the U.S. cycling team successfully used the technique in its favour (winning nine medals, including four gold). It became evident that members of the U.S. cycling team had been practicing blood doping (Pavelka, 1985). This gave rise to ethical concerns by the IOC regarding principles of fair competi-tion. Following these events, blood doping came to be regarded as an illegit-imate performance-enhancing technique and was finally banned in 1986 under the IOC’s anti-doping rules.

The anti-doping raid on the Tour de France in 1998 and the Festina scan-dal that followed marks a new chapter in the history of doping. It became evident that despite the international anti-doping campaign, the use of EPO among professional cyclists had been immense. Moreover, it became clear that doping was no longer an isolated phenomenon; it had become ever more sophisticated and systematic, involving physicians and soigneurs. Willy Voet, the soigneur of the Festina team was stopped with a load of banned pharmaceutical substances in his car. This emerging systematic approach to doping practices became further evident in the USADA’s (U.S. Anti-Doping Agency) report on Lance Armstrong in 2012. Now, it became evident that one was faced with a doping culture.

Future Prospects - Gene Doping

Rapidly increasing knowledge about genetics raises the issue whether this knowledge might soon also be used in the field of sport. In theory, all exist-ing protein levels in the body can be altered through gene therapy. This in-cludes doping related proteins, such as erythropoietin (Epo), Myostatin, and growth hormones, on which the first gene therapy5_{trials have been}

per-formed (Haisma & Hon, 2006). The potential use of this kind of therapeutic technique to enhance athletes’ performance is referred to as gene doping. For instance, an increase of red blood cells and oxygen-carrying capacity, which leads to an increased endurance, can be achieved by inserting a supplemen-tary copy of a gene. The transferred gene will instruct the body to produce new red blood cells (ibid.). Another example is the therapeutic techniques that have been developed to help people with degenerative muscle

5_{Gene therapy refers to transferring genetic material (DNA, RNA, or genetically modified}

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tions such as muscular dystrophy. Such therapeutic techniques may be used to strengthen athletes’ muscles or to increase muscle mass.

Gene doping methods as a new form of doping was added by WADA to the list of “conventional” (chemical) prohibited doping substances and methods (WADA, 2003). It is defined by WADA as: “the non-therapeutic use of cells, genes, genetic elements, or of the modulation of gene expres-sions, having the capacity to enhance athletic performance” (WADA, 2005). As of January 1, 2003, the International Olympic Committee (IOC) has also included gene doping in their list of prohibited methods.

Potential Health Risks Related to Doping

Most doping substances and methods entail health risks for the athletes. This is indeed one of the criteria for a substance or method to be included in the WADA’s Prohibited List. For instance, extensive use of rEPO may lead to heart failure or stroke. Adding red blood cells makes the blood thicker, and this makes it harder for the heart to pump the blood through all tissues in the body (Lage et al., 2002). The underlying ethical principle is the protection of the athlete against harm. Nevertheless, pharmaceutical products (mostly sold “under the counter”) continue to be discovered, the side effects of which have not been adequately tested or are not even known (e.g. efaproxiral, RSR-13 in 2001, and THG in 2003). This shows that some athletes, in their quest for gaining a competitive edge, seem to be ready to go far despite the risk of serious health consequences.

The situation is even more serious in the case of gene doping, in that there are uncertainties regarding the long-term effects of gene modification. These uncertainties are partly due to financial reasons and partly due to the difficul-ties involved in determining reliable paradigms for the study of side effects when it comes to new methods (Haisma & Hon, 2006). Like illicit doping substances, there is a risk that gene transfer procedures are carried out in non-controlled laboratories. Under uncontrolled conditions, gene transfer vectors may become contaminated during production processes with major consequences in terms of safety risks. Moreover, the procedures of germ-line gene transfer are permanent, irreversible, and are transmitted to next genera-tions. This means that in the case of gene doping, the issue of health risk extends beyond the health of the athletes themselves to that of their off-spring.

How Widespread is Doping?

Precise data on the prevalence of doping are difficult to obtain since it is not financially feasible to screen all athletes. Selection for doping testing is

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usu-ally random, e.g. among medal winners, team captains, or athletes who show a sudden or unexpected improvement in personal records. The true frequen-cy of doping tends to be more widespread than anti-doping control data would suggest (Lippi et al., 2008). In the past decades, several surveys have revealed alarming statistics (BMA, Board of Science and Education, 2002). Doping is not just prevalent in elite competitions; it is also prevalent in ama-teur sport and school sport. In France, the incidence of practicing doping in amateur sport is 5-15% (Laure et al., 2000). In 1993, it was estimated by the Canadian Centre for Drug-Free Sport that 83,000 children between the ages of 11 and 18 years had used anabolic steroids in the previous 12 months (Pipe & Ayotte, 2002). An American study indicated that the prevalence of the use of anabolic steroid in adolescents was 4-12% for boys and 0.5-2% for girls (Bahrke et al., 1998). The level of drug use among body builders is alleged to considerably exceed that of the elite athlete (Auge, 1999; Keane, 2005). Keane characterizes the emergence of steroid use as a major public health problem which affects the general population and which is not con-fined only to the world of elite sport (ibid.). Research in the United States, Canada, the United Kingdom and Australia has indicates that steroid use is now widespread among recreational bodybuilders and amateur athletes, (ibid., see also Yesalis et al., 2000). However, the reliability of methods used to estimate the prevalence of doping in sport (mainly relying on self-report) has recently been questioned (see Petróczi et al., 2012).

How Do Athletes Acquire Prohibited Substances?

Athletes can gain access to prohibited medicines from physicians, pharma-cists, retail outlets, health and lifestyle magazines, gymnasiums, coaches, family members, fellow athletes, the internet and the black market. Many physicians may unwittingly write prescriptions for what they believe to be a genuine condition (Sando, 1999). With the prohibition of amphetamines, those disposed to doping turned instead to over-the-counter medicines, which contained ephedrine, pseudoephedrine, phenylephrine and phenylpro-panolamine, and which were accessible in pharmacies. Illegal drugs, includ-ing anabolic steroids, are commonly advertised in lifestyle magazines and gymnasiums. This prevalence is due to the lack of controls on mail order and Internet retails. Most of the high-tech drugs end up on the black market.

Detection Procedures

The introduction of gas chromatography and mass spectrometry in the early 1980’s changed the prospects for success in doping testing. Now, the main problem for anti-doping control tests is that while analytical tests are

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becom-ing increasbecom-ingly complex, the athletes who cheat seem to be one step ahead of the game (Sonsken, 2002). It is obvious that testing methods and applica-tion of the rule of rigorous liability in and of themselves will not necessarily guarantee a clean sport. There are operational irregularities between different nations and sports federations, and advances in this area are hindered by lack of international cooperation (Mottram, 1999). Notwithstanding these diffi-culties, the rapid developments in gene transfer technology (GTT) will even-tually make dope testing control systems outdated; GTT will, for instance, make it possible to increase muscle growth up to 28% (Pipe, 2002). En-hancement in athletic performance that involves the manipulation of ath-lete’s own genes makes it almost impossible to detect (Miah, 2002). Part of this difficulty resides is due to the fact that the DNA that is be used for gene transfer is of human origin and not different from that of the athlete. Howev-er, a way to evade this problem could be to mark gene transfer products with some sort of “bar codes”. Another way of detecting gene doping would be to introduce repeated physiological protein profiling of athletes, allowing for the detection of alterations in protein levels (Haisma & Hon, 2006).

Unintentional Doping

While some athletes intentionally use illicit drugs in order to obtain a com-petitive advantage, others may use substances for other purposes (e.g. medi-cal) without knowing that the particular substance is banned. Whether dop-ing is deliberate or unintentional, the IOC and the National Sports Councils apply the rule of “strict liability”. Today, the penalty for the first-time viola-tion of doping rules by athletes is four years of sport ineligibility and ineligi-bility for sport funding during that period. Second Infraction entails perma-nent sport ineligibility and permaperma-nent ineligibility for sport funding.6

A revision in the definition of doping by WADA now also includes phy-sicians, who could be charged with and found guilty of doping offences. WADA’s 2009 Code defines punishment of medical doctors in article 10.3.2 as follows: “For violation of article 2.7 (trafficking or attempted trafficking) or 2.8 (administration of prohibited substances or prohibited method), the period of ineligibility imposed shall be a minimum of 4 years, and up to lifetime ineligibility (if the anti-doping rule violation involves a minor, and due to a failure of a heightened fiduciary obligation)” (Dikic et al., 2013). It is therefore crucial that athletes (and their medical advisors) have the ability to check all medicines they are using or are considering for use. Athletes need to know which drugs or substances they can and cannot take, including the medicines such as inhalers for asthma that demand preceding

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tion. Unintentional doping may be of particular concern in amateur sports, where means are limited regarding education of participants in anti-doping.

A problem as regards unintentional doping is related to nutritional sup-plements which seems to be virtually unregulated and are directly marketed to athletes. Content and quality cannot always be easily determined and many are purposefully or otherwise impure. The label does not always cover the actual content. Recent studies show that supplements are sometimes con-taminated with prohibited compounds (Maughan, 2005). For instance, many of these supplements contain heavy metals such as mercury, arsenic and lead (Sheehan, 1999). Analysis of 75 supplements obtained over the Internet showed that seven contained undeclared hormones and two contained ephed-rine and caffeine (Kamber et al., 2000). The knowledge about these supple-ments and recommended daily dosage is generally poor and the advertise-ment of these products for financial gain by top athletes worsens the situa-tion. The culture of nutritional supplement in sports needs to be discussed.

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Current Philosophical Debates on Doping

Doping and Health Related issues

As mentioned earlier, one of the central pillars of the anti-doping campaign is concern about athletes’ health. However, some commentators (e.g. Møller, 2010) have argued that one of the features of high-performance sport is that it involves relatively high risks. Damage to muscles, torn ligaments, broken arms and legs, concussions and even death are common in elite sports. Why then should doping be a different matter in this regard? Another approach to health risks can be described as the less-harm principle. According to this view, rather than focusing on drugs, one should concentrate on health. By legalising doping, i.e., permitting safe drugs, one could guarantee athletes’ safety (see Savulescu et al., 2004). Yet, it has been argued that many elite athletes are role models and idols for adolescents; even if one finds their involvement in risky doping behaviour as permissible, one may not wish adolescents to mimic their behaviour. Some substances might also be safe for adult athletes but harmful for adolescents (see, Jost, 2004; Voy, 1991; Paddick, 1990).

Doping and the Spirit of Sport

In addition to concerns for athletes’ health, one of the main reasons given by WADA and other instances for the ban on doping is that doping is “funda-mentally contrary to the spirit of sport.” WADA characterises the “spirit” of sport through values such as: ethics, fair play and honesty; respect for rules and laws; respect for self and other participants; excellence in performance (World Anti-Doping Code, 2009: 14). However, as Loland & Caplan (2008) point out, despite frequent references to the “spirit” of sport in the literature on doping, this concept remains unclear and is in need of more accurate in-terpretations (Loland & Caplan, 2008). In their effort to clarify the concept of the “spirit” of sport, Loland and Caplan offer an interpretation of the spirit of the sport that mainly focuses on the purpose of the sport by emphasising the notion of the “athlete’s autonomy and responsibility for performance” (ibid.: 74). According to this account, the purpose of athletic competition is to measure athletic performance, i.e., the result of a combination of talent, effort and skills. Most performance-enhancing substances and methods that

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are banned by WADA offer the athletes a sort of enhancement involving neither effort nor skills. In such cases, sport “as a measure of athletic effort and performance, loses its significance” (ibid.). Loland and Caplan’s norma-tive stand regarding performance (or achievement) seems to be that “training and competition must cultivate the athlete’s responsibility for performance”, and that “performance should be a result of athletic effort” (ibid: 72, empha-sis added). One could thus maintain that an enhancement-method which bypasses effort is tantamount to an unjustifiable shortcut to achievement.

Some find it doubtful to begin with, that one could assign a general pur-pose to sport. Kious, for instance, doubts that sport, “considered in the ab-stract, has an objective purpose” (2008: 227). Rather, he claims that people who are involved in sport may have different reasons for watching a sport, supporting it or participating in (ibid.). To certain extent, it may be true that the “purpose” of sport is complex. However although Kious suggests people may have different reasons or motives for considering a sport worth watch-ing or pursuwatch-ing, this is not incompatible with the currently agreed upon idea of sport competitions as being a measure of excellence in performance. Un-derstanding the purpose of sport competitions as being a measure of effort and excellence provides, to some degree, a baseline for distinguishing per-missible technologies from those that are not compatible with the spirit of certain sports. For instance, using a motorcycle to win a cycle tournament is in this regard clearly incompatible with the spirit of cycling, while introduc-ing better designed helmets may actually add somethintroduc-ing to that sport, in that it would directly interact with the athletes’ talent and effort and help bring out their best. It also provides an understanding and a way of explaining people’s reactions to doping. Many consider the idea of winning a competi-tion with the aid of performance-enhancing substances and methods appal-ling or troubappal-ling. An example of this is the achievement of Rosie Ruiz, who won the 1980 Boston Marathon by taking the subway for part of the compe-tition. One way to understand the negative reactions would be to say that what she did was a violation of the spirit of sport in the sense that the spirit (and the rules) of Marathon races do not include riding the subway, and do-ing so would simply undermine the very point of what a Marathon race is about.

The above interpretation of the spirit of sport has been challenged by al-ternative interpretations, particularly by those opposing the ban on doping and gene doping. Tamburrini, for instance, maintains that the “essential” purpose of modern competitive sport is “to expand the limit of our [natural] capacities,” something which he believes is compatible with biological ma-nipulation in sport (Tamburrini, 2006: 203). This ideal echoes the more gen-eral ideals about human enhancement in terms of transcending human natu-ral cognitive, mental, and physical limitations through the aid of biotechnol-ogy (see Bostrom, 2006). Along a similar line of argument, Savulescu criti-cises what he refers to as the “old Athenian vision of sport” in which the

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purpose of competitive sport is predominantly to test “natural physical tal-ent” or “biological potential” (Savulescu, 2006: 329). Emphasising the ath-lete’s individual autonomy, he considers biological manipulation as being in line with the human spirit, i.e., “the capacity to improve ourselves [including improving our inborn potentials via biotechnology] on the basis of reason and judgment” (ibid.: 330).

A key point of discrepancy thus seems to be about what should count as athletic excellence. Different perspectives in this regard lead to different understandings of the purpose of sport, and one may distinguish two differ-ent patterns of thoughts, namely, the purpose or spirit of sport as a measure of either:

1. Excellence understood as involving a combination of natural tal-ents, for which the athlete is not responsible and has no control over, plus the category of effort, for which she is responsible, or 2. Excellence understood as the result of a combination of

con-trolled, engineered or improved relevant genetic predispositions and controlled effort.

Though not directly mentioning the spirit of sport, Tännsjö (2009) also criti-cises what he refers to as the “ethos” of elite sport. His view loosely suggests that elite athletic competitions are not “fair” in a strict sense since the win-ners owe their position to talents or genetic predispositions for which they are not directly responsible. Put differently, naturally gifted elite athletes enjoy an exclusive unfair or unjustifiable advantage over others who are the “losers” in the natural lottery. Here one encounters a critique of what is be-lieved to constitute the perceived view of human excellence in the sport community, an ideal which rules out the improvement of inborn natural po-tentials through the help of drugs or genetic manipulation, while stressing the athlete’s reliance solely on innate natural endowments plus his or her

own effort. This ideal is roughly reflected in statements similar to that of

Dick Pond about sport being “essentially a humanistic endeavour to see how far you can go on your own talent” (CBC Sports Online, 2003; cited in Savulescu, 2006).

Doping as a Form of Cheating

Many consider doping as representing a form of cheating. Many of us think of cheating as being unfair. Doping, as a form of cheating, can be understood in terms of gaining advantage over one’s opponent in an unfair manner, or, alternatively, affecting the results of the competition in ways that are unfair. Consider for instance winning a marathon race by taking the subway half the distance. The unfairness in this case could be said to depend on winning the race via a shortcut (the subway), and thus gaining unfair advantage over

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opponents who, following the constitutive rules of marathon, do not resort to such shortcuts in order to win. This wouldn’t in fact be unfair if marathon races allowed for the idea of running the first half and taking the subway in the other half, since if everyone were allowed to do so, then taking the sub-way would not be an unfair advantage exclusive to one athlete. Another analogous way to understand this sense of unfairness would be to regard doping as leading to unequal opportunity among competitors. A competition is meaningful as long as everyone has roughly equal chances of winning. Thus, it could be said that enhancement interventions that are banned are considered to give rise to unjustified inequalities in terms of unfair ad-vantage.

No matter what one feels about current doping regulations, in and of themselves, they can be said to be procedurally fair, so long as they apply equally and indiscriminately to everyone who participates in competitions. The unfairness involved in doping may be understood as benefiting from

exclusive advantages that are not accessible to others (or where the

oppo-nent’s consent is lacking). In other words, for doping to be unfair in this way, it requires that it is not a prevalent phenomenon. If everyone is doped and cheating thus becomes common, then having unfair advantages in the sense described above loses its meaning. Yet, one can never be sure that doping always actually entails unfair advantages, since it is not certain that various doping methods in reality enhance athletic performance. Some ath-letes engage in doping without gaining the desired effect. The reality of to-day’s elite athletic competitions indicates an uncertainty (or anxiety) which many elite athletes face regarding the possibility of opponent’s doping. Hence, those opposing a ban on doping maintain that it is unfair as far as the ban exists. If the ban is removed, the notion of unfair advantage, as well as the uncertainty will disappear. This will, the argument goes, also allow for better research out in the open for developing safe methods, allowing for better considerations of the athletes’ health (see Loland, 2002: 166).

Doping and the Question of Athletes’ Autonomy

From a more liberal vantage point, one might plead to athletes’ autonomy in order to morally justify enhancement, by stressing the athlete’s freedom to chose whatever means necessary to enhance her performance (Savulescu, 2007). According to this view, the anti-doping campaign is perceived as a paternalistic way of limiting athletes’ liberty in pursuing their goals and ath-letic ambitions. Athletes, as autonomous rational beings, should be permitted to pursue their goals, even if it includes the use of performance enhancing substances and methods. However, some commentators believe that remov-ing the ban on dopremov-ing entails a shift of agency from the athletes themselves to that of the bio-medical and technological support systems, hence

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under-mining athletes’ autonomy by reducing them to a mere tool (e.g., Sandel, 2007). Referring to such experiences as East Germany’s doping program, Loland points out that under “the coercive force of the external expert sys-tem, athletes become involved in practices over which they exert little con-trol” (2002: 80). Moreover, it could be argued that removing the ban may push unenhanced athletes to practice doping against their will, in order to be able to compete with those who are enhanced, and this would put them in an unfair position (see Murray, 2010).

Equality in Accessibility

It could be argued that many doping methods are expensive (e.g. gene dop-ing), and that allowing enhancement will result in inequalities with respect to accessibility, since not everyone would have equal access to enhancement technologies. This would be unfair, since fairness requires equal opportunity. This view parallels the broader accessibility discussions (e.g. that of equal access to healthcare) concerning human enhancement. A common counter-argument is that although enhancement technologies currently are expensive, they will soon become more affordable, and lifting the ban would actually contribute to this end, by securing equal access which assures fairness.

Compensation for Natural Inequalities

Not long ago, a relatively small group of people enjoyed certain positional privileges and entitlements due to “nobility of birth”, an unfortunate idea which still exists in some parts of the world. In our modern liberal democrat-ic societies, most find the idea that a person is entitled to a certain social position simply on the basis of being born into the “right” family repugnant. In these societies, in accordance to the modern ideals of equal opportunity and social justice, a person achieves certain position due to his or her merit, and everyone is given equal opportunity to pursue this end. This is at least the ideal. However, modern elite sport tells a different story. As Sandel puts it, we “want to believe that success, in sports and in life, is something we earn, not something we inherit” and the problem is that “natural gifts, and the admiration they inspire, embarrass the meritocratic faith” (2007: 28). The whole point of elite athletic competitions is to distinguish between the best, the good, and the worst. Moreover, biological limitations do not allow eve-ryone to enjoy an equal opportunity to pursue excellence. For the majority, the necessary hard training, determination and dedication do not automati-cally merit a position in an elite league. Without certain natural inborn en-dowments, we do not stand a chance against those who possess them, re-gardless of access to proper gear, diet and training.

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The question may be raised whether modern elite sport entails an una-voidable inherent unfairness, in that elite athletes generally enjoy some sort of “nobility of birth” by being born with certain biological predispositions necessary to achieve excellence. Some believe this to be true and that this is morally problematic (e.g. Tännsjö, 2000; Savulescu, 2009). The nature of elite sport has undeniably been dramatically transformed during the last dec-ades, partly due to recent regulations regarding professionalism in sport. Many elite level sports such as football have now become highly paid “full-time” jobs for many, and have caused a lucrative industry to grow around the elite sport competitions (commercials, gear, fashion, lifestyle, etc.). Many now view the possibility of pursuing a professional career as an elite athlete as a way out of poverty and a chance to obtain fame and fortune. In a sense, raising the questions of fairness and social justice is a consequence of this development in elite sports. In the near future, the feasibility of and the ac-cessibility to human enhancement technologies could heighten the tension between sport’s internal ideals of achievement and excellence, where the focus lies on the combination of effort, skills, and natural talents, and exter-nal general ideals of fairness and social justice. Yet, some (e.g. Murray, 2010) may still insist that elite sports are particular spheres of human activi-ty in which existing genetic inequalities or possessing extraordinary natural endowments are not considered problematic (apart perhaps for a handful of philosophers!).

As an example, once might consider two teenagers, Peter and Paul, who both share a passion for basketball and a dream of becoming professional basketball players. Peter is 2 meters tall and is already a promising athlete, displaying all the physical and mental abilities and skills necessary for be-coming a pro NBA basketball player. Paul is 1.55 meters tall and lacks the most necessary physical conditions for pursuing the same carrier as Peter. Inequalities in relation to innate physical and mental capacities are inevita-ble. However, the question remains, whether, as has been suggested by pro-ponents of enhancement, one should allow enhancement methods which, if available, would help levelling these inequalities, thus rendering the above situation “fair” (e.g., in terms of equality of opportunity)? Well, one may say that this depends on what we mean by “fairness” and/or whether considera-tions of fairness actually are relevant in this case. Rules of basketball and the physical restraints it imposes upon players are certainly contingent. It is even possible to imagine a new form of basketball in which Paul would be con-sidered a better candidate for becoming an elite basketball player than Peter. Many would, however, consider it clearly unfair if Peter and Paul both had (roughly) equal physical and mental preconditions for becoming pro, but Peter got there because of being better looking than Paul, or because he had managed to bribe officials in his favour. The rules of basketball, though being contingent upon the design of the game, are nevertheless procedurally fair as long as they apply indiscriminately and equally to everyone.

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Many of us would not necessarily consider Peter and Paul’s case to be un-fair. As Murry points out, “a match that should never happen is a one-on-one basketball game between LeBron James and me…it may be uninteresting, probably comical, perhaps YouTube-able, but it will not be unfair. He is simply a superior player, not merely to me but probably to every other per-son living on this planet” (2010: 13). For some, the very nature of elite sport remains radically “discriminatory” and “unfair”, hence, the reference to “the inherent unfairness of sport” found in sport literature (see, Edgar, 1998). A core element underlying such a view on elite sport is the assumption of “un-fairness” and “inequality” due to the arbitrariness in nature’s allocation of natural endowments, as developed by Tännsjö (2005; 2009), and Savulescu (2007). This is an “unfairness” which ought to be eradicated by means of enhancement. Tännsjö claims that enhancement “doesn’t seem to have any-thing to do with equal opportunities for anyone to excel”, and that concerns of unfair advantage could be “easily avoided” by ascertaining everyone’s access to enhancement (2009: 324). What he conceives to be problematic in this regard is a special notion of fairness in elite sport which involves:

insisting that we all must accept the ticket we have actually drawn in the ge-netic lottery. Gege-netic differences are not irrelevant to the outcome of the competition…This is a Nietzschean view of justice, according to which it is unfair if those who are less fit pool their resources and rob the genuinely strong Übermensch of his genetic advantage…It [this notion of fairness] is there, all right, but we should get rid of it. Nowhere else in a civilized socie-ty are we prepared to live with this notion of justice (ibid.: 325)

Underlying Tännsjö’s claim regarding elite sport, there seems to be a special view on the natural allocation of endowments, a view that he shares with Savulescu (2007: 330). To put it roughly, this view loosely suggests that elite athletic competitions are not “fair” since the winners owe their position to talents or genetic predispositions for which they are not directly responsi-ble. In this way, elite sport competitions resemble beauty contests (Tännsjö, 2005; Savulescu, 2007). Put differently, naturally gifted elite athletes have an “unfair” advantage over others who are the “losers” in the natural lottery. Thus, this inequality of opportunity is to be levelled by the opportunity to intervene in the natural lottery. Savulescu even moves one step further in this direction and maintains that given this sense of inequality of opportunity, fairness requires enhancement and that this morally obligates us to allow enhancement so that “the winner is not the person who was born with the best genetic potential to be strongest” (Savulescu 2007: 330).

Loland, on the other hand, points out that athletic performances are the outcome of great number of various genetic and non-genetic factors (Loland 2002: 67). There are many random circumstances (socio-economical and environmental factors, mental abilities, etc.) and non-random (training, diet, coaching, etc.) circumstances and factors involved in producing top elite

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athletes. It seems unreasonable to single out one factor or one circumstance as being ultimately decisive in this regard. When it comes to winning, one may agree with Murray in that “a random bounce, a slip, a hesitation can give victory to the side that might lose nine of ten matches” (2010: 14). Few would deny the utmost importance of proper coaching in fully bringing out the potentials of an athlete, potentials that might otherwise not lead to excel-lence, no matter how talented the athlete is.

Equality of opportunity is certainly an admirable ideal. Many would agree with Loland that “inequalities [such as weight] which significantly and sys-tematically influence performance, but which individuals cannot affect in any significant way and for which the therefore cannot be held responsible, ought to be eliminated or compensated for” (Loland 2002: 67). Minor ine-qualities in talent due to bio-motor abilities may be compensated for by learned skills and by acquiring relevant mental qualities (See ibid. for a more detailed discussion of this latter point). However, Tännsjö holds a more radi-cal view in this regard when he asserts:

Today I realize that, no matter how hard I train, I will never be able to run 100-meter sprint final anywhere near as fast as Ben Johnson or Car Lewis did [hence the inequality of opportunity and unfair genetic advantage]. However, when, in the future, I watch a final where the winner runs faster than 5 se-conds, I know that, had I decided to adopt the very same characteristics [via enhancement], I could have done so as well. The winner doesn’t look like me, but looks can be changed. (2005: 67-8)

Loland argues that the consequence of such a strict “egalitarian” view would be that differences in performance become a matter of chance. This, accord-ing to Loland, does not realize the structural goal of sport competitions, namely, the measurement, comparison, and ranking of athletic performance (2002: 72).

Parallel Competitions?

Finally, it could be argued that in order to avoid fairness issues we ought to consider having parallel competition, one in which legal performance en-hancing methods are allowed, and one in which this is not the case7_{. The}

problem with this solution is that this actually might create more problems than it solves. Firstly, this may still push enhanced athletes to seek illegal and unsafe enhancing methods (under the counter) in order to get a competi-tive edge (Murray, 2010). Furthermore, given the existence of such parallel games, there is no guarantee that enhanced athletes will not want to compete

7_{See for instance the debate here:}

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with non-enhanced athletes in order to get a competitive edge. This would certainly be unfair to non-enhanced athletes, and, from a practical point of view, entails that the whole monitoring apparatus must remain intact in order to hinder enhanced athletes from entering non-enhancement competitions. Practically, this means that we must have parallel detecting apparatuses as well.

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Aims and Questions

The overarching aim of this thesis is to investigate the relevance and the importance of the ideas of responsibility in relation to ethical debates on doping. The more specific aim here is to examine the possibility of broaden-ing the scope of responsibility in relation to the dopbroaden-ing culture beyond the individual athlete, and to sketch a theoretical framework within which this expansion could be accommodated.

To this end, I intend to answer the following research questions:

1. Do bioethicists have a moral/professional responsibility in their ap-proach to doping? (Study 1)

2. What are the social and psychological factors underlying athletes’ moral responses to doping behaviour; and what implications might these factors have for our understanding of responsibility in relation to doping behaviour? (Study 2)

3. Is the common individual-based approach to responsibility based on the notion of cheating adequate; and could responsibility in this regard be assigned to individuals and groups of individuals other than the ath-letes themselves? (Study 3-4 and the section Discussion)

4. What are the practical implications of the above questions in terms of the anticipation of potential problems and the development of preven-tive measures regarding the doping culture?